| NPI | 1972013944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23073) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12860) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2023-05-19 |